DA Form 1

PART 9 – FOR COMPLETION OF THE ASSESSMENT MANAGER – FOR OFFICE
USE ONLY

 Date received:                                   Reference number(s):

 Notification of engagement of alternative assessment manager
 Prescribed assessment manager                                     Richard Jones
 Name of chosen assessment manager                                 Richard Jones
 Date chosen assessment manager engaged                            23/02/2024
 Contact number of chosen assessment manager                       1300 596 371
 Relevant licence number(s) of chosen assessment                   A1091364
 manager

 QLeave notification and payment
 Note: For completion by assessment manager if applicable
 Description of the work                                    Short term accommodation cabins
 QLeave project number
 Amount                                                     Date paid
 paid ($)                                                   (dd/mm/yy)
 Date receipted form sighted by assessment
 manager
 Name of officer who sighted the form                       Richard Jones




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                                                                                        DA Form 1 – Development application details
                                                                                                  Version 1.4— 15 December 2023